From the Guidelines
Achilles tendonitis treatment should prioritize eccentric strength training, stretching, and orthotics to reduce tendon strain and promote recovery, as recommended by the most recent and highest quality study 1. Achilles tendonitis is characterized by pain, stiffness, and swelling along the Achilles tendon, typically worsening with activity and in the morning.
- Key symptoms include:
- Pain and stiffness along the Achilles tendon
- Swelling and redness in the affected area
- Worsening of symptoms with activity and in the morning Treatment begins with rest, avoiding activities that cause pain, and applying ice for 15-20 minutes several times daily to reduce inflammation.
- Initial treatment options may include:
- Open-backed shoes to reduce pressure on the area
- Heel lifts or orthoses to unload the tendon
- NSAIDs, such as ibuprofen or naproxen, to manage pain and inflammation
- Decreased activity and weight loss, if indicated
- Stretching exercises, particularly calf stretches, held for 30 seconds and repeated 3-5 times daily Physical therapy focusing on eccentric strengthening exercises, where the muscle lengthens while contracting, is particularly effective, as noted in the study 1.
- Eccentric strength training has been shown to be a popular and effective option for treating Achilles tendinopathy. For persistent cases, a healthcare provider might recommend night splints to maintain tendon flexibility overnight, custom orthotics, or in severe cases, corticosteroid injections or surgery, although local injections of corticosteroids are not recommended as an initial treatment option 1. Recovery typically takes 6-12 weeks, and gradually returning to activities while continuing stretching and strengthening exercises helps prevent recurrence. Achilles tendonitis occurs from repetitive stress causing microtears in the tendon, with risk factors including sudden increases in activity, improper footwear, and tight calf muscles, highlighting the importance of proper treatment and prevention strategies, as discussed in the study 1.
From the FDA Drug Label
Management of Pain, Primary Dysmenorrhea, and Acute Tendonitis and Bursitis Because the sodium salt of naproxen is more rapidly absorbed, naproxen sodium is recommended for the management of acute painful conditions when prompt onset of pain relief is desired. The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
The symptoms of Achilles tendonitis are not explicitly described in the label, but the treatment for acute tendonitis is mentioned.
- The recommended starting dose of naproxen is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
- The initial total daily dose should not exceed 1250 mg of naproxen.
- Thereafter, the total daily dose should not exceed 1000 mg of naproxen 2.
From the Research
Achilles Tendonitis Symptoms
- Pain in the Achilles tendon, which connects the calf muscles to the heel bone 3, 4, 5, 6
- Pain can be worse with activity, especially running or jumping 4, 6
- Swelling or thickening of the tendon 4, 5
- Stiffness or limited mobility in the ankle 5, 6
Treatment Options
- Conservative management, including physical therapy and eccentric exercises, is often the first line of treatment 3, 4, 5, 6
- Eccentric exercise training is considered the gold standard for treating Achilles tendinopathy 3
- Other treatment options may include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) may be used to reduce pain and inflammation, but their effectiveness in treating tendinopathy is unclear 7